CHICAGO — In a sunlit room down a white hallway in St. Bernard Hospital on Chicago’s South Side, Francine and Rodney Mitchell are waiting.

Their teenage son, Andy, lies on an operating table not far away, asleep amid the beeps of monitors, the hiss and thump of an oxygen machine, and the unmistakable, high-pitched whir of a dental drill. Andy has intellectual and physical disabilities, is not easily able to communicate or control his own body, and though he has survived and even thrived under the care of two dedicated parents, routine dental care has been difficult to obtain.

Like many people with special needs in the U.S., Andy has suffered with untreated tooth decay. He has been in pain and now has cavities in 23 teeth, bone loss around his front teeth, and eight teeth that will need to be extracted before his treatment today is over. “He can’t really tell you when something hurts,” says his father. “He’ll just ball up and cry.”

The Mitchells knew that Andy’s teeth needed care but struggled to find dentists who were willing or able to help. “We tried to take him to a neighborhood clinic,” Rodney says, “but they didn’t want to touch him. A lot of dentists won’t touch special-needs people.” Rodney also took Andy, in his wheelchair, to an open clinic day at the University of Illinois at Chicago, one of the few places that is known as a treatment option for patients with special needs. They left home at 6 a.m., but when they arrived, he says, the line was like Disney World — hourslong. They gave up and went back home.

Finally, through staff at La Rabida Children’s Hospital, the Mitchells heard about a dental clinic at St. Bernard.

‘There is nowhere else for them to go’

Monique Davis, the office manager for the dental clinic, steps into the room, and the Mitchells eye her somewhat warily. Davis beams — it’s just what she does. She spends her days bustling through the hospital hallways, keeping the clinic on track, but her main job, as she sees it, is to reassure and make comfortable people whose everyday struggle has honed their tenacity to a sharp edge. Her mission is clear: She is here to help. “We specialize in special-needs patients,” she tells the Mitchells. “There is nowhere else for them to go, so even if insurance becomes a problem, we will work with you. We are just a small community hospital, but we see everybody here. We do everything.” The Mitchells are quiet, but they nod, ask a couple of questions, relax a bit. Davis smiles her huge smile again. “Don’t worry,” she says. “We’re taking care of him now.”

By many measures, the hospital dental clinic at St. Bernard seems an unlikely place of refuge. Situated near the Dan Ryan Expressway in Englewood, a neighborhood which has long been used as Chicago shorthand for urban blight and crime, it’s in a squatty, unassuming brick hospital building on a quiet street. Police cars come and go outside the emergency room entrance, and a steady stream of visitors and patients make their way past the security desk at the main door. The hospital lacks a marquee reputation among the city’s lauded medical centers. There is no groundbreaking medical research here.

Instead, there is an unlikely group of people who have found an unusual sense of purpose around fixing teeth. “When I became a dentist,” says Dr. Mary Joyce Gomez, director of the St. Bernard dental clinic, “I wanted to be a pastor, a minister. My mom said, ‘No, you be a doctor, you can serve people that way.’ I was thinking, ‘How can you really serve people by just filling their teeth?'” A year and a half ago, Gomez gave up a comfortable private practice in the Loop to become dental director at St. Bernard because, she says, she realized she had found a place where she could finally realize that dream.

‘The haves and have-nots’

The St. Bernard dental clinic, founded in 2007, treats a patient population that is largely insured by Medicaid. Under Gomez’s leadership, the clinic expanded its mission. Though services were available for children with special needs, she added care for adults with special needs — a group that finds dental care extremely hard to access.

“Oral care in the U.S. is really a story of the haves and have-nots,” says Jane Koppelman, senior manager of the Pew Charitable Trust’s dental campaign. “It is not a problem for the well-off, but it’s an incredible problem for people who are low-income.” Since 2008, Pew has been studying dental health in America, and its research has revealed that about 30 percent of the U.S. population has no access to dental care. That number is disproportionately made up of low-income Americans. “Dental care,” says Koppelman, “is out of reach for 125 million Americans.” Cost is the principal barrier, but access plays a role too: “There are large pockets of underserved areas in inner cities, rural areas or other areas where dentists and other health care practitioners don’t care to reside or practice,” says Koppelman.

Though there is little data on patients with special needs, specifically, “anecdotally,” says Koppelman, “we have seen that the issue for special-needs populations is particularly acute.” Patients with special needs are often unable to sit in a dental chair for routine care or longer procedures, and thus are more apt to need general anesthesia, which few dental offices can provide. In addition, this population may have a greater barrier to transportation and other basic concerns involved in getting to a dentist. Among the subset of dentists who treat patients with special needs, many treat only children, meaning that even those patients who can get care may age out of access to that service.

For patients or caregivers who have already navigated so many hurdles, finding a welcome like the one at St. Bernard can seem nearly miraculous. In a world that often answers “no,” the dental clinic is a place built on “yes.”

“I teach my staff,” Gomez says, “we don’t turn anyone away.”

Living on hope

She understands adversity, she says, because she has had to navigate a few hurdles of her own to get to this place. Growing up in the Philippines, she was the daughter of a dentist father and a mother who doggedly pursued her own education after being orphaned. “She was the one with the vision,” Gomez says, and her vision for her children was that they would all be doctors. Her father, she recalls, “would always tease me and say, ‘Your feet are like mine. Maybe you will follow in my shoes.'” When he died, just before she turned 18, her mother only pushed harder to ensure her children’s success. In time, Gomez’s brother became a physicist with a doctorate, her sister a medical doctor, and Gomez a dentist.

“I was fine practicing in the Philippines,” she says, but on a visit to the U.S. to see her brother in Maryland, her mother decided that America was the place for Gomez, as well. “She said, you will be successful here.” Somewhat reluctantly, Gomez agreed to try, and traveled to California to take a bench test that would allow her to receive a U.S. license to practice. Her mother, who had planned to come along to support her, had been diagnosed with cancer and had to remain behind. “The test was on Friday,” she says. “On Wednesday night, she called me and prayed for me. On Thursday night, she died.”

Determined to go on because it was what her mother wanted, Gomez took the test the next day and passed — only to learn that the program that would have allowed her to receive a license after passing the test had been discontinued.

She applied for a green card, intending to go to dental school in the U.S. “That was in 2000,” she says. “And in 2001, 9/11 happened. So the green card that would have taken three years took nine.” She waited, working as a dental assistant in Maryland for nine years. “By the time I finally got the green card,” she says, “I told my husband, ‘I’m too old for this now!'” Still, she applied and was accepted at the University of Illinois at Chicago College of Dentistry.

A year into the program, she faced another setback: “I felt a lump and was diagnosed with breast cancer.”

At school, she was initially told she would need to reapply to the dental program once her treatment was finished. “I felt like everything crashed in on me,” she says. “I was living on the hope that there was a plan of me becoming a dentist, but now I’m sick, I am in dental school. Now I have student loans. How am I going to pay this? How am I going to pay rent?” In the end, a sympathetic dean relented and helped her return to the program once she was well, and she graduated in the top of her class.

After graduation, she took a residency in Peoria, working with low-income populations. “Many of them were feeling, ‘How am I going to lift myself up out of this? I have no money. I have nothing.’ And we were like a beacon of hope. We gave them a little bit of hope. And all of a sudden, you would see them transformed.”

She saw firsthand the impact dental health has on many aspects of life: Poor dental care is not only the source of chronic pain that results in poor performance and absenteeism at work and in school, but can be the source of deteriorating health overall. Today, according to the American Dental Association and the Surgeon General, studies suggest links between oral health and diabetes, heart disease and stroke, and lack of proper dental care has been viewed as part of an ongoing public health crisis for more than a decade.

But Gomez was also interested in the psychosocial effects of better dental care. According to the American Dental Association, 37 percent of low-income adults in Illinois say that the condition of their mouth or teeth affects their ability to interview for a job. “We would give them a total smile makeover,” she says, “and all of a sudden, they would come in smiling, looking up. ‘Hey, I went for a job interview.'” For Gomez, the effects were revelatory: “I saw a patient population that I could touch.”

‘This might be it’

Though she settled into a comfortable routine with a private practice in downtown Chicago, Gomez felt that something was missing. Then, in 2017, she saw a job posting for a new dental director at St. Bernard. In her mind, something clicked into place. “Sometimes people think of dentistry as just filling teeth,” she says, “or you do it for the money. But there is something there that you need to find, something to move you. I saw this job, and I thought, ‘This might be it.'”

Suddenly, she saw her own path in life in a new light. “All those experiences, see how they fall into place? Being on the side of being the patient made me more compassionate to the patients. Being an assistant for a long time made me understand the staff. I understand them when they are tired, frustrated — been there, done that. All the obstacles and hindrances make me more thankful, more grateful every day. So now everything has a meaning. We have to care.”

The more she researched St. Bernard, the neighborhood, the work to be done, the more strongly she felt about her mission. Colleagues questioned the idea, “‘Are you sure you want to go there?’ And even my husband and my brother weren’t sure. But they know me, I am …” she laughs, “kind of stubborn, you know, in a nice way. I’m like, ‘OK, yes, I will consider that. Thank you for your input.’ But my mind is made up.”

Knowing she would need to put all of her energy into the work at St. Bernard, she sold her downtown practice. “This is a full-time-plus-100 job,” she says. “I put everything here — not only my time, but everything, I’m so invested.”

Once at St. Bernard, she began recruiting other dentists, exploring partnerships with UIC dentists and dealing with a patient backlog. She sought out like-minded young dentists like Abby Stern and Chi-Lan Pham, who are starting in public service dentistry fresh from dental school.

“You feel this weight of being the only one who will see these patients,” says Stern, “of wanting to do your job well enough that you are able to be that for them.” Stern isn’t sure everyone understands that urgency. “My parents are still surprised that this is the route I took,” she says. “I think they still think I’m going into private practice. It’s just the perception, ‘Oh you’re going to go to dental school, you’re going to make a lot of money, you’re going to have a comfortable life.'” But, like Gomez, that isn’t what Stern has in mind: “I want to be in public health for my career. I want to pursue it not for any income or status but just to better the community. There’s a lot of need, and we see it every day.”

Gomez is intent on meeting that need, whether it means wearing a crown to turn a kid’s dental visit into a visit from a tooth-fairy princess, or spending her day in the operating room, performing multiple extractions and fillings on a 47-year-old patient with special needs whose anxiety wouldn’t allow her to sit still for dental X-rays.

The issue of better dental care for low-income people and patients with special needs is a nearly overwhelming problem, but her goals go beyond meeting that need. In a community that has rarely been afforded even the basic services that are readily available elsewhere in Chicago, Gomez believes that she can make a difference that starts with fixing teeth, and goes much further.

“Every day, I see so much anger in people,” she says. “When you’re angry, you get anger back. But I try to impress on our staff that people come here with all kinds of other problems. Don’t take it personally like they are mad at you, but treat them with care. Because when you treat them with care, they will feel it, and when they feel it, that changes the whole thing. They will understand that there are still people out there who care.”

Her mission — her ministry — has always been about more than fillings and root canals. “It’s not only the teeth, it’s the people that we can care for. We need to care for them, give them what they need and also a little bit of hope.”

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